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The efficacy of systemic therapy for unresectable advanced hepatocellular carcinoma (aHCC) has not been proven in patients with Child-Pugh (C-P) B cirrhosis. Nevertheless, in real-world these patients are treated with tyrosine-kinase inhibitors (TKIs) since their toxicity is similar to that observed in C-P A patients and, off-label, with Metronomic Capecitabine (MC) in patients not amenable to TKIs. This study aimed to compare Sorafenib and MC's outcomes versus best supportive care (BSC) in C-P B-HCC patients. Between 2008 and 2020, among 774 consecutive C-P B patients with aHCC not amenable/responding to locoregional treatments extracted from the ITA.LI.CA database, 410 underwent Sorafenib, 62 MC, and 302 BSC. The propensity score matching method was used to correct the baseline unbalanced prognostic factors, with a 1:1 allocation of Sorafenib vs BSC, MC vs BSC, and Sorafenib vs MC patients, and Kaplan-Meier method and Log-rank test were used to define overall survival (OS) and differences. in the unmatched population median OS (95% CI) was 9.9 (8.3-11.4) months in Sorafenib, 8.0 (0.4-15.7) months in MC, and 3.9 (3.1-4.8) months in BSC-treated patients (p<0.001 for Sorafenib vs BSC and for MC vs BSC; p=0.812 for Sorafenib vs MC). In Sorafenib vs BSC-matched patients (135 couples) median OS was 7.3 (4.8-9.7) vs 3.9 (2.6-5.2) months (p<0.001). Independent predictors of survival were ECOG-Performance Status >1 [HR: 1.61 (1.22-2.13)], tumour size [HR: 1.04 (1.01-1.07)] macrovascular invasion [HR: 1.48 (1.12-1.96)], AFP >400 ng/mL [HR: 1.52 (1.14-2.04)], treatment-naïve [HR: 1.54 (1.15-2.07)] and Sorafenib [HR: 0.51 (0.38-0.68)]. In MC vs BSC matched patients (40 couples) median OS was 9.0 (0.2-17.8) vs 3.0 (2.2-3.8) months (p<0.001). In Sorafenib vs MC-matched patients (55 couples) the median OS did not differ (p=0.283). C-P B patients with aHCC undergoing BSC have poor survival. Both Sorafenib and MC treatment improve their prognosis. [ABSTRACT FROM AUTHOR]

Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcoholic aetiology associates with a worse prognosis compared to hepatitis B and C infections, due to a lower percentage of HCCs diagnosed under regular surveillance and a higher comorbidity burden in alcoholic patients. This study aimed at describing the evolving clinical scenario of alcohol-related HCC over a 15-year period (2006-2020) in Italy. Data of the Italian Liver Cancer (ITA.LI.CA) registry were used: 1391 alcoholic patients were allocated to 3 groups based on the year of cancer diagnosis (2006-2010; 2011-2015; 2016-2020) and patient characteristics, HCC treatment and overall survival were compared among groups. Survival predictors were also investigated. Around 80% of alcoholic patients were classified as metabolic dysfunction-associated fatty liver disease (MAFLD) cases. Throughout the quinquennia, <50% of HCCs were detected by surveillance programs. The tumour burden at diagnosis slightly decreased but not enough to change the distribution of ITA.LI.CA cancer stages. The use of intra-arterial and targeting systemic therapies increased across quinquennia. A modest improvement of survival was observed in the last quinquennia, particularly after 24 months of patient observation. Cancer stage, HCC treatment and presence of oesophageal varices were independent predictors of survival. In the last 15 years, minor improvements have been obtained in the outcome of alcohol-related HCC, mainly because of a persistent underuse of surveillance programs and the consequent steadily low amenability to curative treatments. Oesophageal varices are an independent grim prognosticator and therefore this variable should be included in prognostic systems. MAFLD is a widespread condition in alcohol abusers, but its presence did not achieve a pivotal prognostic role once HCC has developed. [ABSTRACT FROM AUTHOR]

Summary: Objective: Aim of this study was to describe the main characteristics of food-borne disease outbreaks (FBDOs) in the French armed forces from 1999 to 2009. Methods: FBDOs are reported to the military epidemiological surveillance system, which concerns all active military personnel. Investigation reports published from 1999 to 2009 were reviewed. Results: Among the 180 FBDOs reported, 48.3% occurred overseas. The mean reporting rate was 2.4 outbreaks p.100,000 in France and 26.7 p.100,000 overseas, reaching to 39.3 p.100,000 in Africa. Digestive symptoms were predominant among cases. Laboratory analyses on cases were positive in 29.4% of FBDOs. The most frequently isolated agents were shigella (15.4%). Laboratory analyses on food samples were positive in 18.9% of outbreaks, the most frequently isolated agent being Clostridium perfringens (15.7%). Only 7 FBDOs were documented by concordant analyses in both patients and food samples. Conclusions: The reporting rate was much higher among military deployed overseas, which can be the consequence of a lack of hygiene due to operational imperatives and the consumption of local food which does not meet safety standards. In operational settings, laboratory evidence may be difficult to obtain and a timely epidemiological investigation in some cases proves valuable to identify the likely vehicle of infection and to guide targeted intervention measures. [ABSTRACT FROM AUTHOR]

Abstract: Background.: Thalidomide, an anti-angiogenic agent, does not have a good therapeutic effect for advanced hepatocellular carcinoma when used alone. Megestrol and interleukin-2 have been proposed as a palliative treatment for hepatocellular carcinoma. Aims.: We assessed the effectiveness/safety of a combined therapy with thalidomide+megestrol+interleukin-2 in cirrhotic patients with advanced hepatocellular carcinoma. Patients and methods.: Nine cirrhotic patients with advanced hepatocellular carcinoma received oral megestrol (160mg/day) and thalidomide (from 50mg/day to the maximal tolerated dose). Four patients also received subcutaneous interleukin-2 (1 million U/day for 21 days/month). Results.: The maximal tolerated dose of thalidomide was 150mg/day. All patients complained of sedation and other neurological or digestive adverse effects. In all but one patient the adverse effects disappeared after thalidomide withdrawal or dose reduction. Interleukin-2 administration caused a flu-like syndrome and a reaction at the injection site. During treatment, alpha-fetoprotein increased in six patients, remained stable in two and decreased in one. Eight patients showed tumour progression and one had a stable disease. Eight patients died. The median survival was 9.9 (range 2.6–18.6) months. Conclusion.: In cirrhotic patients, the combined treatment with thalidomide+megestrol (±interleukin-2) does not control hepatocellular carcinoma growth, possibly due to the low tolerance to thalidomide and interleukin-2 preventing the use of appropriate dosages. [Copyright &y& Elsevier]